Precertification Nurse

Job Description
About Medlogix

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients' needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers' compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

Overview:

The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries.

Knowledge:

• New Jersey Auto PIP / No-Fault - Preferred
• InterQual/Review Manager/CERME
• CPT and ICD-9/ICD-10 diagnosis coding
• Medical management related to auto claims - Preferred
• Microsoft Office Suite programs
• Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar

Skills:

• Strong interpersonal skills, communication and presentation
• Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes
• Ability to work independently
• Ability to provide instruction and direction to support staff
• Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws
• Must be detail oriented and able to multi-task
• Must be able to type 45-50 words per minute

Experience:

• 3 Years Med-Surg - Required
• Utilization Review - Preferred
• Ortho/Rehab - Preferred

Required Education:

• Graduate of an accredited school of nursing

Required License or certification:

• Active New Jersey State Nursing License in good standing - LPN/RN